UnitedHealthcare Coverage for HA Injections
UnitedHealthcare covers hyaluronic acid injections for knee osteoarthritis on most plans, but prior authorization is typically required. Coverage details vary by specific plan.
Quick Facts
| Coverage Aspect | Details |
|---|---|
| Covered? | Yes (most plans) |
| Prior Authorization | Required |
| Network | In-network strongly recommended |
| Your Cost | Varies by plan |
Prior Authorization: Critical Requirement
Prior Auth Required
UnitedHealthcare requires prior authorization for viscosupplementation. If you get treatment without approval, your claim may be denied entirely.
How to Get Prior Authorization
- Your provider submits request to UHC
- Include required documentation:
- OA diagnosis with X-ray evidence
- Record of conservative treatments tried
- Medical necessity explanation
- Wait for approval (typically 5-15 days)
- Get approval number before treatment
Coverage Requirements
Medical Necessity Criteria
UHC typically requires:
- Diagnosis: Knee osteoarthritis (ICD-10 M17.x)
- Imaging: X-ray showing OA changes
- Failed conservative treatment:
- Physical therapy (4-6 weeks)
- NSAIDs or other medications
- Activity modification
Plan Variations
| Plan Type | Coverage Notes |
|---|---|
| Employer plans | Coverage varies by employer selection |
| Individual plans | Check specific benefits |
| UHC Medicare Advantage | Follows Medicare guidelines |
| Medicaid managed care | State-specific requirements |
What You’ll Pay
Your costs depend on your UHC plan:
| Plan Feature | Typical Cost |
|---|---|
| Copay (in-network) | $50-$150 |
| Coinsurance | 20-30% |
| Deductible applies | Check your plan |
| Out-of-network | Significantly higher |
Tips for Approval
Before Requesting Authorization
- Document conservative treatment thoroughly
- Get recent X-rays (within 12 months)
- Choose in-network provider
- Know your plan benefits
If Initially Denied
- Request denial reason in writing
- Ask for peer-to-peer review (doctor talks to UHC medical reviewer)
- Submit formal appeal with additional documentation
- Request external review if internal appeal fails
UHC Medicare Advantage
If you have UHC Medicare Advantage:
- Coverage follows Original Medicare guidelines
- Prior authorization may still apply
- Network restrictions typically apply
- Copays vary by plan